Showing papers in "American Journal of Surgery in 1971"
TL;DR: Low doses of laser were found to stimulate the regeneration not only of mechanically induced wounds but also of burns, suggesting that wound-healing stimulated by laser radiation involves an increased rate of epithelial growth, which may eventually be the starting point of neoplastic growth.
Abstract: Low doses of laser were found to stimulate the regeneration not only of mechanically induced wounds but also of burns. The wound-healing stimulated by laser radiation involves an increased rate of epithelial growth, which may eventually be the starting point of neoplastic growth.
685 citations
TL;DR: The clinicopathologic findings in ninety cases of carotid body tumors seen at the Mayo Clinic from 1931 through 1966 are compared with those in 500 reported cases in the literature, finding that Group 3 tumors are usually large and incarcerate the carotids.
Abstract: The clinicopathologic findings in ninety cases of carotid body tumors seen at the Mayo Clinic from 1931 through 1966 are compared with those in 500 reported cases in the literature. In the ninety cases reviewed here, there were sixty-two men and twenty-eight women. In twenty cases surgery had been performed elsewhere; seventy patients were operated on here, with total excision in forty-nine, including one patient with bilateral tumors. The over-all surgical mortality rate was 5.7 per cent, usually related to carotid arterial damage or ligation. There were no tumor recurrences, although cervical node metastasis was noted in one patient and spinal metastasis in another. A classification was suggested for future surgical cases. Group 1 tumors are relatively small and minimally attached to the carotid vessels. Surgical excision usually can be carried out without difficulty. Group 2 tumors are usually larger and show moderate arterial attachment. These tumors are amenable to careful surgical removal. Group 3 tumors are usually large and incarcerate the carotids. Here the tumor must be approached with great care and vessel replacement should be considered.
663 citations
TL;DR: Malignancy is associated with intussusception much more frequently than was appreciated in earlier literature and with this in mind, the treatment of choice for all types of int Mussusception in adults is resection without reduction whenever possible.
Abstract: Two important points should be remembered in treating intussusception in adults: 1. 1. Malignancy is associated with intussusception much more frequently than was appreciated in earlier literature. It was associated with 24 per cent of cases of enteric intussusception and 54 per cent of all colonic intussusception in this report. 2. 2. With this in mind, the treatment of choice for all types of intussusception in adults is resection without reduction whenever possible.
451 citations
TL;DR: Although the depilatory preparation does not contribute to the risk of wound infection, the razor preparation has a definite adverse effect and support is provided for the concept that bacterial liberation and growth after razor preparation injury is responsible for this adverse effect.
Abstract: The influence of the method of hair removal, razor versus depilatory, on the risk of postoperative wound infection was studied in 406 cases. The infection rate was 5.6 per cent after razor preparation, 0.6 per cent after depilatory, and 0.6 per cent after no preparation. After razor preparation, the infection rate was 3.1 per cent when done just prior to surgery, 7.1 per cent when done up to twenty-four hours prior to surgery, and 20 per cent when done over twenty-four hours before surgery. The infection rate after razor preparation was not influenced by the presence or absence of visible injury. These findings suggest that although the depilatory preparation does not contribute to the risk of wound infection, the razor preparation has a definite adverse effect. Support is provided for the concept that bacterial liberation and growth after razor preparation injury is responsible for this adverse effect. Further, the microscopic injury that regularly accompanies the razor preparation is sufficient explanation without the necessity to implicate visible injury
309 citations
TL;DR: Impairment seen on preoperative pulmonary function studies, obesity, smoking, and prolonged anesthesia time increased postoperative pulmonary complications, particularly in patients having elective upper abdominal surgery.
Abstract: Preoperative and postoperative measurements of the FVC, FEV1, pCO2, O2 saturation, and pH were taken in forty-six patients having elective upper abdominal surgery. Postoperatively, the FVC and FEV1 were reduced by 65 per cent and all patients demonstrated hypoxemia. A significant difference existed in the FVC and FEV1 of the “normal” subjects versus those subjects in whom macroatelectasis developed. Impairment seen on preoperative pulmonary function studies, obesity, smoking, and prolonged anesthesia time increased postoperative pulmonary complications.
253 citations
166 citations
TL;DR: Data have been presented indicating that the mandible may be preserved in a higher percentage of patients, and clinical application in a small number of patients has provided good results.
Abstract: 1. 1. Data have been presented indicating that the mandible may be preserved in a higher percentage of patients. 2. 2. Clinical application in a small number of patients has provided good results. 3. 3. Clinical criteria for the selection of patients have been outlined.
165 citations
TL;DR: Irrigation of contaminated wounds with either 70 per cent ethyl alcohol, benzalkonium chloride, 0.25 per cent chloramine, aqueous iodine, tincture of iodine, povidone-iodine, or crystal violet provided significant protection against the development of frank infection in contaminated wounds.
Abstract: The purpose of this study is to assess the effectiveness of antiseptic agents in the treatment of a reproducible experimental wound infection. 1. 1. Irrigation of contaminated wounds with either 70 per cent ethyl alcohol, benzalkonium chloride, 0.25 per cent chloramine, aqueous iodine, tincture of iodine, povidone-iodine, or crystal violet provided significant protection against the development of frank infection in contaminated wounds. The effectiveness of irrigation with these various antiseptic agents in the treatment of contaminated wounds did not differ significantly. 2. 2. Irrigation of wounds with dilute solutions of either ethyl alcohol (10 and 56 per cent) or chloramine (0.1 per cent) was ineffective in the treatment of the contaminated wound. 3. 3. Treatment of contaminated wounds by irrigation with 0.5 per cent silver nitrate solution enhanced the incidence of wound infection. 4. 4. Irrigation of contaminated wounds with solutions of carbolic acid (1 to 5 per cent) was regularly associated with early mortality from phenol poisoning. Treatment of contaminated wounds with a more dilute solution of carbolic acid (0.5 per cent), which did not kill the animals, was ineffective in providing protection against the development of subsequent infection.
158 citations
TL;DR: The clinical course, treatment, and results in this series of forty-three patients with osteogenic sarcoma of the facial and cranial bones during the thirty-seven year period from 1930 to 1966 are described.
Abstract: Osteogenic sarcoma is a highly malignant and rare bone tumor. Its skeletal incidence has been estimated at one case per 100,000 of the general population in the United States [I]. Approximately 6.6 per cent of all osteogenic sarcomas arise in the jaws. At the Memorial Sloan-Kettering Cancer Center we have recovered the records of fortythree patients with osteogenic sarcoma of the facial and cranial bones during the thirty-seven year period from 1930 to 1966 in whom adequate data and pathologic material were available. The microscopic slides have been reviewed by one of us (SIH) and the diagnoses confirmed. Several other patients with osteogenic sarcoma of the facial and cranial bones are listed in the Tumor Registry but have been excluded because of lack of adequate records, lack of pathologic material for review, or because the diagnosis could not be confirmed. This report describes in detail the clinical course, treatment, and results in this series of forty-three patients. Clinical Data
154 citations
TL;DR: The hepatic artery classification has a more direct significance to surgery of the upper abdominal organs than those proposed by anatomists and was illustrated in cases of tumors of the liver and pancreas.
Abstract: By means of selective arteriography, anatomic variations of the hepatic artery in 200 patients were observed. They were classified into three groups on the basis of the number of the hepatic arteries. The classification has a more direct significance to surgery of the upper abdominal organs than those proposed by anatomists. The single hepatic artery classification was applicable in 58.5 per cent of the cases, in which the normal “textbook” pattern was limited to 53.5 per cent (107 of 200 cases). The double hepatic artery group consisted of 37.0 per cent of the cases and the multiple hepatic artery group 4.5 per cent. Each group was further divided into the celiac, mixed, and mesenteric types according to the origin of the hepatic artery. Combination of the three groups and three types yielded twentyseven different distribution patterns of the hepatic artery. In addition, surgical significance of the classification was illustrated in cases of tumors of the liver and pancreas.
148 citations
TL;DR: Acquired urachal disease, causing a true acute abdominal condition, elicited by supervening complications, is described on the basis of the literature and the present series.
Abstract: The urachus forms in early embryonic life as a tubular communication between the bladder lumen and the allantois. After birth the bladder descends and the urachus undergoes varying degrees of regression during which its lumen normally closes. Various diseases may affect the urachus. Their symptoms, signs, and pathologic anatomy are reviewed. A common feature of these conditions is partial reopening of the lumen of the regressive urachus. The distinction between congenital and acquired urachal diseases is made. Five cases of acquired urachal disease, observed in a department of abdominal surgery, are reported. It is emphasized that the symptoms and signs were suggestive of acute abdominal conditions caused by intra-abdominal diseases. Acquired urachal disease, causing a true acute abdominal condition, elicited by supervening complications, is described on the basis of the literature and the present series. Therapeutic principles are discussed, taking into account the possibility of malignant degeneration of the urachus and the high recurrence rate in acquired urachal disease.
TL;DR: A new method for transhepatic portacaval shunting accomplished on a percutaneous basis by puncture of the jugular vein and by the use of a modified Ross needle-catheter system is described.
Abstract: A new method for transhepatic portacaval shunting accomplished on a percutaneous basis by puncture of the jugular vein and by the use of a modified Ross needle-catheter system is described. The shunt was accomplished in forty dogs and the technic was used successfully in cadavers. The shunt technic and its possible clinical application are discussed.
TL;DR: Distal washout to prevent continued contamination from fecal material remaining in the defunctionalized rectosigmoid was employed in ten casualties in addition to the conventional measures, which resulted in a striking reduction in complications and no mortality.
Abstract: We have reviewed the management of twentynine casualties with rectal injuries terated in Vietnam. A high incidence of virulent complications and a 22.2 per cent mortality occurred in eighteen casualties treated by conventional means with a divided sigmoid colostomy, rectal repair when feasible, and presacral drainage. The complications and deaths were invariably related to pelvic sepsis. Distal washout to prevent continued contamination from fecal material remaining in the defunctionalized rectosigmoid was employed in ten casualties in addition to the conventional measures. This resulted in a striking reduction in complications and no mortality. We also stress the importance of prompt diagnosis, direct control of hemorrhage, proper management of associated injuries, and adequate debridement.
TL;DR: The use of chemically defined liquid diets with bulk-free, relatively nonstimulating of biliary, pancreatic, and intestinal secretions, and almost completely absorbed by the upper small bowel provided nutritional maintenance without exacerbating fistula drainage and suggests that the use of such diets provides an effective method of maintaining nutritional support of fistula patients via the gastrointestinal tract.
Abstract: Adequate nutritional care of patients with a fistula of the gastrointestinal tract has been shown to reduce the mortality and encourage spontaneous closure. Thirteen patients with fistulas of the gastrointestinal tract were nutritionally supported via the gastrointestinal tract with chemically defined liquid diets for five to fifty days. These diets were bulk-free, relatively nonstimulating of biliary, pancreatic, and intestinal secretions, and almost completely absorbed by the upper small bowel, and they provided nutritional maintenance without exacerbating fistula drainage. Positive caloric, nitrogen, potassium, and magnesium balance was achieved in a significant number of patients. While on diets, the patient's weight was maintained and serum protein levels were significantly increased. Over 50 per cent of the fistulas closed spontaneously and a mortality of 15.4 per cent was achieved. This suggests that the use of such diets provides an effective method of maintaining nutritional support of fistula patients via the gastrointestinal tract, and further trials are warranted.
TL;DR: It is concluded that pancreaticoduodenectomy represents a justifiable procedure for chronic relapsing pancreatitis with pancreatic lithiasis, if other operative measures or previous lesser operations have failed to manage this distressing and often devastating disease.
Abstract: 1. 1. Experience with pancreaticoduodenectomy performed in sixty-three patients for chronic relapsing pancreatitis with stone formation is summarized. It has been emphasized that careful preand intraoperative evaluation is necessary before a radical operation for relapsing pancreatitis is performed. 2. 2. A successful operative technic for resection of the duodenum and the head of the pancreas is presented in some detail. With this procedure only one operative death occurred in the entire series. 3. 3. Of the sixty-three patients, six were lost to follow-up study. Of the remaining fifty-seven patients, forty-two were alive and fifteen dead at the end of three years. Of the forty-two living patients, results were good in thirty-one patients, fair in six, poor in two, and bad in three at the first period of follow-up three years after operation. The maintenance of early improvement was closely related to whether or not the patient took an adequate diet and abstained from further alcoholic intake. The patient who would not stop drinking was much less likely to realize prolonged benefit from the operation. 4. 4. It is concluded that pancreaticoduodenectomy represents a justifiable procedure for chronic relapsing pancreatitis with pancreatic lithiasis, if other operative measures or previous lesser operations have failed to manage this distressing and often devastating disease. Pancreaticoduodenectomy should not be performed until less hazardous forms of treatment have been given a full clinical trial and have failed.
TL;DR: Analysis of mortality after operation allows separation of patients with end-stage myocardial insufficiency into three groups, finding heart transplantation in appropriately selected cases offers a substantial probability for return to normal activity.
Abstract: In the past two and a half years twenty-six patients have received heart transplants at Stanford Over-all survival is 45 per cent at six months, 38 per cent at twelve and eighteen months, and 30 per cent at two years Analysis of mortality after operation allows separation of these patients into three groups Three patients died within seventy-two hours of operation, all secondary to markedly elevated pulmonary vascular resistance resulting in progressive right heart failure (group I) Nine patients died in the hospital within two months of operation of infection or rejection (group II) Thirteen patients were discharged in satisfactory condition one to four months after operation (group III) One patient died in the early postoperative period from a cerebrovascular accident apparently unrelated to transplantation Patients in group I differed significantly from those in groups II and III in having a higher pulmonary artery mean pressure and a higher calculated pulmonary vascular resistance Patients in group II differed from those in group III with respect to age and the duration of known heart disease No differences were found between the three groups with respect to number of HL-A antigen mismatches, duration of severe heart disease, cardiac index, mean left atrial pressure, or preoperative bilirubin or blood urea nitrogen levels Follow-up study of the thirteen patients who survived the immediate postoperative period shows 84 per cent survival at six months, 75 per cent at twelve and eighteen months, and 60 per cent at two years For patients with end-stage myocardial insufficiency, heart transplantation in appropriately selected cases offers a substantial probability for return to normal activity
TL;DR: Exposure of bowel causes increased evaporative heat loss which can, in experimental animals, cause a pronounced fall in body temperature, and these problems can be avoided by enclosing the bowel in a plastic envelope and irrigating the abdominal cavity with warm saline solution after the bowel has been returned to the abdomen cavity.
Abstract: Exposure of bowel causes increased evaporative heat loss which can, in experimental animals, cause a pronounced fall in body temperature. Return of the cold exposed bowel to the abdominal cavity causes a further fall in body temperature. These problems can be avoided by enclosing the bowel in a plastic envelope and irrigating the abdominal cavity with warm saline solution after the bowel has been returned to the abdominal cavity.
TL;DR: Patients were divided into four anatomic groups which regionally involve similar problems in treatment and often result in similar cosmetic and functional deformities, but there are also some notable differences in recurrences and total survival depending on the anatomic location of the primary lesion.
Abstract: The records of eighty-one patients with adenoid cystic carcinoma of major and minor salivary glands at Roswell Park Memorial Institute have been reviewed. Survival data on sixty-five patients followed five years or more reveals an average survival of 7.4 years. Sixty-five per cent (forty-two of sixty-five patients) lived for five years, 31 per cent (twenty of sixty-five) for ten years, and 15 per cent (ten of sixty-five) for fifteen years or longer. The patients were divided into four anatomic groups which regionally involve similar problems in treatment and often result in similar cosmetic and functional deformities. Similarities are seen but there are also some notable differences in recurrences and total survival depending on the anatomic location of the primary lesion. Aggressive surgical resection and reconstruction is the preferred method of therapy for both primary and locally recurrent disease whenever possible. Local recurrences and systemic metastases are common, but are often delayed for several years. Locally recurrent tumor can be controlled in many instances by surgical resection or radiotherapy, but careful lifetime follow-up study of the patient is required to discover recurrent disease at its earliest stage.
TL;DR: Although the number of patients was too small to draw firm conclusions, the technic of combined hyperalimentation and chemotherapy appears to aid the management of patients with advanced symptomatic malignant disease.
Abstract: Combined parenteral hyperalimentation and systemic chemotherapy have been employed in a group of ten patients with widespread malignant disease. Although only two patients had objective changes in the size of lesions, almost all patients had decreased analgesic requirements, improved performance status, increased appetite and oral intake, and reversal of the downward weight trend. There was a striking absence of gastrointestinal toxicity despite the administration of extremely large doses of chemotherapeutic agents over prolonged periods of time. Although the number of patients was too small to draw firm conclusions, the technic of combined hyperalimentation and chemotherapy appears to aid the management of patients with advanced symptomatic malignant disease.
TL;DR: Patients who experienced perforated colonie diverticula while receiving adrenocorticosteroid therapy presented clinical features which differed from those who had diverticular perforation but were not receiving steroids, and consideration should be given to exteriorization or resection of the perforations at the first procedure.
Abstract: 1. 1. Eleven patients who experienced perforated colonie diverticula while receiving adrenocorticosteroid therapy presented clinical features which differed from those who had diverticular perforation but were not receiving steroids. 2. 2. A high index of suspicion for this potentially lethal catastrophe is necessary to establish the diagnosis in patients who usually present without prior gastrointestinal symptoms. 3. 3. Early operation is mandatory in these patients, and consideration should be given to exteriorization or resection of the perforation at the first procedure. 4. 4. In addition to adversely affecting the course of diverticular perforation, long-term adrenocorticosteroid therapy may actually predispose to such perforation.
TL;DR: This is an unusually large series of lipomas in the hand and wrist, which caused some element of nerve compression and prompt removal of the compressing lipoma will usually restore normal function to the affected nerve.
Abstract: Case material of a series of 112 lipomas that were surgically excised from the upper extremity are reviewed. Twelve of the tumors occurred in the hand and three occurred at the wrist. This is an unusually large series of lipomas in the hand and wrist. None of the tumors in the palm and fingers caused any nerve compression. Six lipomas in the total series caused some element of nerve compression. Since lipomas rarely cause nerve compression, all six of these cases are described in some detail. Prompt removal of the compressing lipoma will usually restore normal function to the affected nerve.
TL;DR: A case of traumatic renal arteriovenous fistula with an unusually short interval between the occurrence of trauma and diagnosis of the fistula and a relatively rare direct communication to the vena cava is presented.
Abstract: Renal arteriovenous fistula, a rather uncommon entity, has received increasing recognition due to advances in angiographic technics and the unique association of high output cardiac failure and diastolic hypertension. A case of traumatic renal arteriovenous fistula with an unusually short interval between the occurrence of trauma and diagnosis of the fistula and a relatively rare direct communication to the vena cava is presented. The clinical and radiographic features of this and 117 other reported cases are reviewed.
TL;DR: An analysis of the results of axillary-femoral bypass demonstrates that a single axillary artery can restore satisfactory blood flow to both lower extremities, but the late patency of the reconstruction does not compare favorably with conventional intra-abdominal aortic reconstruction.
Abstract: An analysis of the results of axillary-femoral bypass demonstrates that a single axillary artery can restore satisfactory blood flow to both lower extremities, but the late patency of the reconstruction does not compare favorably with conventional intra-abdominal aortic reconstruction. Technical modifications, including the use of a 10 mm weaveknit prosthesis combined with a crossover femorofemoral bypass, have substantially improved late patency, so that a comparison of the cumulative patency rates with this prosthesis closely parallels the cumulative survival rate of the group of poor risk patients for whom the operation was intended. Current indications for the use of the operation include the restoration of blood flow to the leg after removal of an infected intra-abdominal prosthesis, and treatment of advanced ischemia in elderly poor risk patients in whom conventional intra-abdominal vascular reconstruction carries a high morbidity and mortality.
TL;DR: Distal pancreatectomy should be employed whenever transection of the gland or duct is involved whereas pancreatoduodenectomy should be reserved for combined injuries of the pancreas and duodenum or extensive damage to the head of the glands with compromise of the blood supply to the duod intestine.
Abstract: The management of pancreatic injuries in forty-four patients was reviewed. The over-all mortality was 20 per cent. Delay in the diagnosis of pancreatic injury in nine patients and persistence in nonoperative therapy in another six patients recognized to have pancreatic injury resulted in the frequent occurrence of fistula, abscess, hemorrhage, and death. The presence of a completely transected pancreatic duct was not recognized beneath what appeared to be a hematoma or contusion of the pancreas in six patients. The importance of evaluating the integrity of the ductal system in patients with a pancreatic contusion, hematoma, or necrosis is emphasized. Only two of fourteen patients avoided reoperation after sump drainage of major pancreatic injuries. Distal pancreatectomy should be employed whenever transection of the gland or duct is involved whereas pancreatoduodenectomy should be reserved for combined injuries of the pancreas and duodenum or extensive damage to the head of the gland with compromise of the blood supply to the duodenum.
TL;DR: Early active surgical treatment and careful postoperative observation provide the optimal therapy for the patient with primary mesenteric venous occlusive disease.
Abstract: Primary mesenteric venous occlusive disease occurs infrequently but the mortality rate is high. A review of the clinical records of twenty-two patients with this condition revealed an over-all mortality of 59 per cent and a surgical mortality of 52 per cent. Anticoagulation therapy seemed to be an important factor in reducing the mortality rate. A significant number of patients had a prodroma for many days before seeking medical care. Early active surgical treatment and careful postoperative observation provide the optimal therapy for the patient with primary mesenteric venous occlusive disease. A “second look” is indicated if the disease progresses or recurs.
TL;DR: Aggressive medical and surgical therapy directed at the underlying cause for the embolus represents the most important means of reducing mortality.
Abstract: Three hundred thirty embolectomies were carried out in 300 patients. Morbidity and mortality relate to well defined areas. The method of management of difficult technical problems is related. Aggressive medical and surgical therapy directed at the underlying cause for the embolus represents the most important means of reducing mortality.
TL;DR: It was the opinion of the pathologist that the alterations found represented acute rejection, but it is believed that limited arterial perfusion may have contributed substantially to the atrophic changes observed.
Abstract: The experimental intestinal transplantation in our laboratory and elsewhere is briefly reviewed. Replantation of the entire jejunoileum is compatible with long-term survival of experimental animals. Lymphatic pathways severed during the procedure fully regenerated within a few weeks. Contrary to the implication of earlier studies on this subject, it is now believed that intestinal allografts are rejected in the same manner as other organs, and the rejection response is definitely mitigated by immunosuppressive drugs. There is no conclusive evidence of a graft versus host reaction despite the fact that transplantation of the entire jejunoileum represents a large antigenic mass and transplantation of many mesenteric lymph nodes. The time necessary for regeneration of lymphatic pathways after allotransplantation is different from that after replantation. In an eight year old boy with surgical removal of the entire jejunum and ileum, repeated problems with infection at catheter sites precluded intravenous feeding after four months. A 3 foot length of terminal ileum from his mother (a class B match) was transplanted, both ostia being opened as mucous fistulas to the abdominal wall. On the seventh day the recipient was explored because of the necrotic appearance of the stomas and a perforated duodenal ulcer. The allograft was precariously perfused and of questionable viability. It was removed to forestall possible further intraabdominal complications. Microscopic examination revealed extensive ischemic necrosis. The large vessels were open but the small vessels contained little blood. It was the opinion of the pathologist that the alterations found represented acute rejection, but we believe that limited arterial perfusion may have contributed substantially to the atrophic changes observed.